The Health Care Team Concept

Health Care Team

Patient care almost always requires teamwork. It would be arrogant for the doctor to believe that s/he is the only barrier between the patient and disease. The whole health care team – doctors, nurses, secretaries, office staff, therapists, pharmacists, dietitians, social workers, various technicians, care partners, aides and sometimes even family members - is important. The absence of any member would reduce the team’s ability to provide quality care. The doctor may be the leader of this team as the main decision-maker; however, I prefer to view the patient care team as a partnership with the primary goal of improving the welfare of the patient.

If you are the physician leading the team, you have the responsibility of utilizing the various talents of the team for the best effect on improving the patient’s medical care. Talk to your patient’s nurse. Find out what’s going on. Let him or her know what you’re thinking about with respect to the patient and what your ultimate plans are. Listen to the concerns and suggestions of the health care team members. This will keep you and your patient out of trouble more times than not. It will also help you learn more about your patient. There may be key pieces of the history discovered by the nurse that the patient didn’t think was important enough to tell you about.

The partnership concept of the health care team for each patient should be obvious and self-evident, and there are multiple benefits. However, there are many physicians who prefer to “go solo”, believing that they are the only members of the team that matter. They frequently treat other health care professionals very condescendingly, for no other purpose, it seems, than to establish the physician as the higher authority, or because s/he somehow believes that demeaning the person is going to make them want to do better. This erodes and destroys the integrity of the team and renders it dysfunctional. This is not improving patient care. In fact, it almost certainly has a deleterious effect for several reasons.

The health care team professional that is repeatedly reprimanded for little or no wrongdoing becomes very anxious in the care of that particular patient or patients under the care of that doctor. S/he becomes less confident in his/her ability to render care and comfort and indeed, may end up spending less time with the patient than s/he would have otherwise. In addition, s/he is afraid to call the physician to clarify orders or to inform the doctor of certain things that could become problems, with the incentive being to leave it for the next shift. The inclination of that individual will be to avoid that physician when s/he is making rounds rather than being supportive and informative.

I’m not saying that certain incorrect actions or inactions should be ignored, but they should be dealt with on equal footing with the person at fault – not condescendingly but by way of providing information to the person. If it is a serious transgression or if the problem is occurring repeatedly, then you have to let his or her superior know about it. If you are the employer, then you have to discuss the situation i>privately and with as little emotion as possible.

Similarly, the physician should not take offense at suggestions that are provided from other members of the health care team. The suggestions are not, or should not be, intended to find fault with what the doctor is doing or not doing, but rather another way of helping the patient that perhaps the physician hadn’t considered. None of us are perfect. We need to recognize this fact early in our careers. We cannot let our egos and our pride get in the way of patient care. If you are the physician, listen to your patient’s health care team. You have the final say, but don’t ignore their input (assuming they have the patient’s best interest at heart).

Having said that, I would always be a little cautious taking the advice of anyone who has any other agenda besides, or even in addition to, the welfare of the patient. These include, but are not limited to, hospital or office administrative personnel, or anyone whose job it is to save money for the accounting department. Also included are sales people, pharmaceutical representatives, or even your own office personnel who just want to go home early. These are not bad people. They just have their own jobs or situations pulling them in a slightly different direction. They want your patients to do well also, and they certainly all have their place in the health care arena; but they are not always as focused on what’s best for your individual patient as you are.